Coronary Artery Disease and Sudden Unexplained Death in Patients on Dialysis: A Propensity Score-Matched Cohort Study.

Background: To investigate the link between coronary artery disease (CAD) and sudden unexplained death (SUD) in patients undergoing dialysis and coronary angiography.

Methods: We performed coronary angiography in 1,883 out of 3,080 dialysis patients on the waitlist for transplant following a prespecified protocol and 1,044 were included in the study using a propensity-match analysis and estimated by logistic regression to adjust for potential confounding variables and match. Patients with significant CAD were selected for medical treatment or coronary intervention. Cumulative incidence curves were constructed using the Aalen-Johansen method and compared by using Gray's test.

Results: A total of 1,044 patients were split into 2 equal groups, with 522 subjects in each group based on the presence of CAD. CAD was associated with a nonsignificant 37% increased risk of SUD (hazard ratio 1.37 [0.83-2.24], P = 0.21). Among the 277 patients who underwent coronary intervention, the risk of SUD was reduced by 59% (hazard ratio 0.41 [0.23-0.72], P = 0.002).

Conclusions: In patients undergoing dialysis and coronary angiography, CAD was not related to SUD. In a group with more severe and widespread CAD, coronary intervention was found to be associated with a reduced incidence of SUD. The data suggest that an invasive assessment of CAD may be beneficial in select dialysis populations for identifying and treating individuals at increased risk of SUD.